Atherosclerosis Factors Research Articles

Evaluation of the Risk of Malignant Arrhythmia Through Electrocardiography Parameters in Patients with Urinary Stone Disease

Introduction: With a lifetime frequency of 10-15% and a recurrence rate of up to 50% within 10 years, urinary stone disease is a major cause of comorbidity. Recently, it has become widely recognized that urinary system stone disease is not only limited to kidney stone development but is also linked to cardiovascular disease and various other illnesses. Malignant arrhythmias (sudden cardiac death and ventricular arrhythmias) are consequences of coronary artery disease. Despite numerous studies demonstrating that urinary system stone disease is a risk factor for coronary artery disease, no electrocardiographic parameters have been evaluated in this patient group This prospective observational study aims to assess ventricular repolarization parameters using electrocardiography, which are risk indicators for malignant arrhythmias in patients with urinary stones disease. Materials and Methods The study included patients diagnosed with urinary stone disease and healthy volunteers. All patients underwent 12-lead electrocardiography. The electrocardiographys were evaluated for QTc interval, QTc dispersion, T peak-end interval, and Tp-e/QTc, and compared with the control group. Results: When comparing the QTc interval, QTc dispersion, T peak-end interval, and Tp-e/QTc parameters between the patient and control groups, no statistically significant differences were found. Conclusion: Contrary to existing knowledge, this study found that malignant arrhythmias in patients with urinary stone disease were not significantly different from the normal population.

Perivascular Fat: A Novel Risk Factor for Coronary Artery Disease.

Perivascular adipose tissue (PVAT) interacts with the vascular wall and secretes bioactive factors which regulate vascular wall physiology. Vice versa, vascular wall inflammation affects the adjacent PVAT via paracrine signals, which induce cachexia-type morphological changes in perivascular fat. These changes can be quantified in pericoronary adipose tissue (PCAT), as an increase in PCAT attenuation in coronary computed tomography angiography images. Fat attenuation index (FAI), a novel imaging biomarker, measures PCAT attenuation around coronary artery segments and is associated with coronary artery disease presence, progression, and plaque instability. Beyond its diagnostic capacity, PCAT attenuation can also ameliorate cardiac risk stratification, thus representing an innovative prognostic biomarker of cardiovascular disease (CVD). However, technical, biological, and anatomical factors are weakly related to PCAT attenuation and cause variation in its measurement. Thus, to integrate FAI, a research tool, into clinical practice, a medical device has been designed to provide FAI values standardized for these factors. In this review, we discuss the interplay of PVAT with the vascular wall, the diagnostic and prognostic value of PCAT attenuation, and its integration as a CVD risk marker in clinical practice.

The interactions of lipoprotein(a) with common cardiovascular risk factors in coronary artery disease, calcific aortic valve stenosis and ischemic stroke

The interactions of lipoprotein(a) with common cardiovascular risk factors in coronary artery disease, calcific aortic valve stenosis and ischemic stroke

Relationship Between CHA₂DS₂-VASc Score on Admission and In-Hospital Major Adverse Cardiovascular Events in Patients Diagnosed With ST-Elevation Myocardial Infarction.

The CHA₂DS₂-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, sex) scoring system, which includes conventional risk factors of coronary artery disease, was originally created to quantify the risk of thromboembolism in patients with atrial fibrillation. This study evaluated the usefulness of this score to predict adverse outcomes in STEMI (ST-elevation myocardial infarction) patients without atrial fibrillation. Primary end points were identified as MACE (major adverse cardiovascular events) which included in-hospital death or cerebrovascular accident. MACE rate was 10% (193 patients). The CHA₂DS₂-VASc score was an independent predictor of MACE (95% CI, 2.31 [1.37-3.9]; P = .0016). Other independent predictors of MACE included heart rate (95% CI, 1.56 [0.97-2.50]; P = .0242), admission Killip class (95% CI, 24.19 [10.74-54.46]; P < .0001), admission creatinine level (95% CI, 1.54 [1.10-2.16]; P = .0024), peak CK-MB level (95% CI, 1.63 [0.98-2.70]; P = .0001), and no-reflow (95% CI, 2.45 [1.25-4.80]; P = .0085). A nomogram was developed to estimate the risk of in-hospital adverse outcomes for STEMI patients. The CHA₂DS₂-VASc score was an independent predictor of MACE in STEMI patients. Linear analysis of CHA₂DS₂-VASc score without dichotomization was the main difference of this study from others.

RISK factors for coronary artery disease in chronic liver disease

RISK factors for coronary artery disease in chronic liver disease

Smoking is a predominant risk factor for coronary artery disease among Indians.

Smoking has emerged as a predominant risk factor for coronary artery disease (CAD) in India, contributing significantly to the country's rising cardiovascular morbidity and mortality rates. The adverse effects of tobacco on cardiovascular health are well-documented, exacerbating a public health challenge in a nation with a high prevalence of smoking. Therefore, it is of interest to analyse the impact of smoking on the incidence and progression of coronary artery disease among the Indian population, emphasizing the need for targeted public health interventions to mitigate this risk factor. We included 1000 adults were enrolled from January to July 2023. The group comprised 500 CAD patients (cases) and 500 individuals without CAD (controls). We gathered information on demographics, smoking habits & other CAD risk factors. To assess the relationships between smoking, CAD, and other variables, we utilized multivariate logistic regression. The analysis revealed that current smokers had a substantially increased likelihood of CAD, with an unadjusted odds ratio (OR) of 3.20 (95% CI: 2.45-4.18), compared to non-smokers. This association remained significant even after adjusting for confounders, with an adjusted OR of 2.80 (95% CI: 2.10-3.75). The study confirms smoking as a critical, Adaptable risk element for CAD, independently increasing the risk of the disease. Smoking significantly elevates the risk of developing coronary artery disease among Indians. Comprehensive anti-smoking campaigns and stringent tobacco control policies are imperative to reduce the burden of CAD. Public health strategies must focus on awareness, prevention, and cessation support to combat this major health threat effectively.

CircARCN1 aggravates atherosclerosis by regulating HuR-mediated USP31 mRNA in macrophages.

Circular RNAs (circRNAs) are considered important regulators of biological processes, but their impact on atherosclerosis development, a key factor in coronary artery disease (CAD), has not been fully elucidated. We aimed to investigate their potential use in patients with CAD and the pathogenesis of atherosclerosis. Patients with stable angina (SA) or acute coronary syndrome (ACS) and controls were selected for transcriptomic screening and quantification of circRNAs in blood cells. We stained carotid plaque samples for circRNAs and performed gain- and loss-of-function studies in vitro. Western blots, protein interaction analysis, and molecular approaches were used to perform the mechanistic study. ApoE-/- mouse models were employed in functional studies with adeno-associated virus-mediated genetic intervention. We demonstrated elevated circARCN1 expression in peripheral blood mononuclear cells from patients with SA or ACS, especially in those with ACS. Furthermore, higher circARCN1 levels were associated with a higher risk of developing SA and ACS. We also observed elevated expression of circARCN1 in carotid artery plaques. Further analysis indicated that circARCN1 was mainly expressed in monocytes and macrophages, which was also confirmed in atherosclerotic plaques. Our in vitro studies provided evidence that circARCN1 affected the interaction between HuR and ubiquitin-specific peptidase 31 (USP31) mRNA, resulting in attenuated USP31-mediated NF-κB activation. Interestingly, macrophage accumulation and inflammation in atherosclerotic plaques were markedly decreased when circARCN1 was knocked down with adeno-associated virus in macrophages of ApoE-/- mice, while circARCN1 overexpression in the model exacerbated atherosclerotic lesions. Our findings provide solid evidence macrophagic-expressed circARCN1 plays a role in atherosclerosis development by regulating HuR-mediated USP31 mRNA stability and NF-κB activation, suggesting that circARCN1 may serve as a factor for atherosclerotic lesion formation.

A Study to Assess the Knowledge Regarding Management of Modifiable Risk Factors of Coronary Artery Disease Among Patients with Diabetes Mellitus in a Selected Diabetic OPD of Dharwad District with a View to Develop an Information Guide Sheet

A Study to Assess the Knowledge Regarding Management of Modifiable Risk Factors of Coronary Artery Disease Among Patients with Diabetes Mellitus in a Selected Diabetic OPD of Dharwad District with a View to Develop an Information Guide Sheet

Clinical and echographic parameters as risk factors for atrial fibrilation in patients with hypertophic cardiomyopathy

Abstract Introduction Hypertrophic cardiomyopathy is the most prevalent inherited cardiomyopathy characterized by left ventricular hypertrophy and manifests with atrial fibrillation in 25% of patients, correlating with heightened morbidity and mortality rates. Purpose To investigate the clinical and echocardiographic parameters associated with the occurrence and progression of atrial fibrillation in patients diagnosed with hypertrophic cardiomyopathy. Material and Methods The study sample consisted of 72 patients with hypertrophic cardiomyopathy attending the Hereditary Heart Disease Unit at a tertiary cardiac surgery center. Thorough examination of patients' medical records was conducted. Results Myocardial fibrosis was observed in 68.1% of the patients. Analysis of the data revealed that atrial fibrillation (AF) episodes were more prevalent in older individuals (p=0.035) with a lower ejection fraction (p=0.003). Additionally, a larger left atrial diameter of 49.8mm (p&amp;lt;0.001), functional stage according to NYHA III (p=0.015), a history of syncope/pre-syncope events (p=0.018), patients with an implanted pacemaker/defibrillator (p=0.003), and those with known coronary artery disease factors (p=0.032), particularly dyslipidemia (p=0.049) and diabetes mellitus (p=0.027), were associated with higher AF incidence. Conclusions . This study underscores the importance of recognizing clinical and echocardiographic factors that contribute to atrial fibrillation risk in hypertrophic cardiomyopathy, enabling early identification of high-risk individuals and implementation of preventive strategies to reduce the frequency of atrial fibrillation episodes and associated complications.

Association between the atherogenic index of plasma and coronary collateral circulation in patients with chronic total occlusion

BackgroundThe atherogenic index of plasma (AIP) is considered an independent risk factor for coronary artery disease (CAD). The present study investigated whether AIP correlates with the formation of coronary collateral circulation (CCC) in CAD patients with chronic total occlusion (CTO).MethodsThis retrospective study included 1093 CAD patients with CTO confirmed by coronary angiography from January 2020 to December 2020 at Beijing Anzhen Hospital. Based on the Rentrop scoring system, the patients were divided into the good CCC group and the poor CCC group. AIP was calculated by log (triglyceride/high-density lipoprotein cholesterol). Meanwhile, the study population was further divided into four groups according to the quartiles of AIP.ResultsPatients in the poor CCC group exhibited significantly higher AIP compared to those in the good CCC group (0.31 ± 0.27 vs. 0.14 ± 0.24, p < 0.001). Multivariate logistic regression analysis revealed an independent association between AIP and poor CCC, regardless of whether AIP was treated as a continuous or categorical variable (p < 0.001), after adjusting for confounding factors. Besides, this association remained consistent across most subgroups. The incorporation of AIP into the baseline model significantly enhanced the accuracy of identifying poor CCC [area under the curve (AUC): baseline model, 0.661 vs. baseline model + AIP, 0.721, p for comparison < 0.001].ConclusionsElevated AIP is independently associated with an increased risk of poor CCC in CAD patients with CTO, and AIP may improve the ability to identify poor CCC in clinical practice.

Evaluation of Plasma Atherogenic Index, Triglyceride-Glucose Index and Other Lipid Ratios as Predictive Biomarkers of Coronary Artery Disease in Different Age Groups.

(1) Background: Dyslipidaemia and insulin resistance are major risk factors for coronary artery disease (CAD). This study investigated the relationship between plasma atherogenic index (PA-I), triglyceride-glucose index (TGI) and other lipid ratios with the presence and prediction of CAD among different age categories. (2) Methods: The study included 223 participants diagnosed with CAD and those with normal coronary arteries (normal group) by coronary computed tomography angiography (CCTA). Participants were categorised by age and sex: premature CAD (PCAD) for men under 55 and women under 65, and older groups as elderly. (3) Results: PA-I, Lipid Combined Index, Castelli Risk Indices, and TGI were significantly higher in the PCAD group compared to the control group (p < 0.05). ROC analysis showed that a PA-I cut-off of 0.41 had a sensitivity of 62% and a specificity of 58% for predicting PCAD, while a TGI cut-off of 8.74 had a sensitivity of 68% and a specificity of 62%. In the elderly, no significant differences in these indices were found between the CAD and normal groups. (4) Conclusions: Traditional lipid profiles and non-traditional lipid indices such as PA-I and TGI show significant differences in predicting CAD in younger populations but not in older groups. TGI and PA-I may be promising biomarkers for the prediction of PAD, although further validation is needed.

Correlation of Vitamin C with Risk Factors of Coronary Artery Disease to Measure the Disease Prognosis to Prepare a Diagnostic Strategy

Abstract BACKGROUND: Reports depicted insufficient plasma Vitamin C levels and significant associations to both acute and chronic inflammation. Recently, use of intravenous Vitamin C has gained visibility for its effectiveness in coronavirus-19 treatment. There were no studies available currently to detect the clinical correlation between plasma Vitamin C with risk factors of coronary artery disease (CAD). The present aim of the study is to estimate the Vitamin C levels in CAD patients as well as to correlate with clinical and laboratory variables to assess the severity of CAD and also to formulate a diagnostic strategy. METHODS: A prospective comparative study was conducted in 100 diagnosed cases of CAD and estimate plasma Vitamin C levels and compared with healthy individuals. Spearman correlation analysis was performed between Vitamin C levels and risk factors of CAD. RESULTS: Maximum CAD cases were in the age group of 60–70 years. The mean age was 58.54 ± 11.60 years in the CAD patients. Among risk factors, 54% of patients had hypertension, 54% of patients had diabetes mellitus, and 27% of patients had dyslipidemia. There significant association noted between diabetes and type of CAD (P = 0.015). Among CAD cases, 70% of patients had ST-elevation myocardial infarction (STEMI), 11% of patients had a non-ST-elevation myocardial infarction (NSTEMI), 17% of patients had unstable angina (USA), and only 2% of patients had central sleep apnoea (CSA). Angiogram diagnosis shows that 34% of patients had single-vessel disease (SVD), 28% of patients had double-vessel disease (DVD), 8% of patients had triple-vessel disease (TVD), 2% of patients had left main coronary artery (LMCA) disease, 13% patients had mild CAD, and 15% patients had normal epicardial coronaries. The range of plasma Vitamin C concentrations level was from 33.25 to 92.5 μmol/L in CAD patients. The mean plasma Vitamin C concentration levels in CAD patients were lower than in healthy individuals (66.96 ± 13.6 vs. 71.33 ± 10.8 μmol/L). There was no statistically significant difference between CAD and non-CAD for plasma Vitamin C concentration levels (P = 0.085). The mean Vitamin C level was higher in DVD (70.6 ± 10.9) than the TVD, LM (71.6 ± 5.82), SVD (68.49 ± 12.4), mild CAD (65.55 ± 13.1), and TVD (62.92 ± 8.9). There was no statistically significant difference in plasma Vitamin C levels in the coronary angiogram (CAG) diagnosis for CAD cases (P = 0.103). The mean plasma Vitamin C levels were higher in NSTEMI (72.98 ± 10.8) than the STEMI (69.5 ± 12.5), USA (63.6 ± 15.2), and CSA (58.45 ± 3.5) μmol/L. There was no statistically significant difference in plasma Vitamin C levels in the type of CAD (P = 0.135). A negative correlation is noted between Vitamin C and low-density lipoprotein (LDL) cholesterol (r = −0.32, P = 0.02). Similarly, there is a negative correlation between Vitamin C and TGL (r = −0.28, P = 0.0067), whereas there is a positive correlation between Vitamin C and high-density lipoprotein (HDL) (r = 0.27, P = 0.0025). CONCLUSION: The mean of Vitamin C concentration levels was lower in CAD patients than in healthy individuals. There is a significant negative correlation between Vitamin C and LDL and between Vitamin-C and TGL. A positive correlation was observed between Vitamin-C and HDL. Vitamin C along with HDL was markedly decreased in CAD and may be the cause. Hence, the combination of Vitamin C, LDL, and HDL can be considered prognostic detectors to know the CAD at its early stages.

Impact of Smoking on Hematologic and Biochemical Predictors of Coronary Artery Disease in Iraqi Male Population

Background: Smoking is a well-known risk factor for coronary artery disease (CAD) and other cardiovascular conditions, including coronary heart disease (CHD). Blood cell components and biomarkers such as white blood cells (WBCs), haemoglobin (Hb), fibrinogen, high-sensitivity C-reactive protein (hs-CRP), D-dimer, and ferritin have been implicated in the pathogenesis of CAD. This study aimed to identify key predictors of CAD in smokers by assessing these hematologic and biochemical parameters. Methods: This study included male smokers with hypertension, excluding those with diabetes or dyslipidaemia, and compared them to a control group of healthy nonsmokers. Parameters assessed included complete blood count (CBC) and blood-based biomarkers (hs-CRP, D-dimer, fibrinogen, and ferritin). The predictive value of the fibrinogen-to-D-dimer ratio was also analyzed. Statistical analysis was conducted using GraphPad Prism 9.5.0 with a 95% confidence level. Results: Significant differences were observed between smokers and nonsmokers in WBC count, Hb level, and packed cell volume (PCV). Smokers exhibited higher levels of hs-CRP, fibrinogen, D-dimer, and ferritin. However, the fibrinogen-to-D-dimer ratio was not a significant predictor of CAD. Conclusion: The study found that elevated WBC count, Hb level, PCV, and biomarkers (hs-CRP, D-dimer, fibrinogen, ferritin) are strong predictors of CAD in smokers. These findings suggest the potential for developing a predictive panel for CAD risk in smokers, though the study's small sample size is a limitation.

An Exploration of Shared Risk Factors for Coronary Artery Disease and Cancer from 109 Traits: The Evidence from Two-Sample Mendelian Randomization Studies.

Although observational studies have reported several common biomarkers related to coronary artery disease (CAD) and cancer, there is a shortage of traditional epidemiological data to establish causative linkages. Thus, we conducted a comprehensive two-sample Mendelian randomization (MR) analysis to systematically investigate the causal associations of 109 traits with both CAD and cancer to identify their shared risk and protective factors. The genetic association datasets pertaining to exposure and outcomes were reviewed using the most recent and public genome-wide association studies (GWAS). Inverse variance weighting (IVW), weighted median (WM), and MR-Egger strategies were implemented for the MR analyses. The heterogeneity and pleiotropy were measured utilizing leave-one-out sensitivity testing, MR-PRESSO outlier detection, and Cochran's Q test. The IVW analyses revealed that genetic-predicted mean sphered cell volume (MSCV) is a protective factor for CAD, and weight is a risk factor. MSCV and weight also show similar effects on cancer. Furthermore, our study also identified a set of risk and protective factors unique to CAD and cancer, such as telomere length. Our Mendelian randomization study sheds light on shared and unique risk and protective factors for CAD and cancer, offering valuable insights that could guide future research and the development of personalized strategies for preventing and treating these two significant health issues.

THROMBOLYSIS IN ST- ELEVATION MYOCARDIALINFRACTION PATIENTS: CLINICAL PREDICTORS OF REPERFUSIONAND ANGIOGRAPHIC OUTCOMES

Background: Thrombolysis is an alternative strategy for reperfusion in the management of ST- Elevation Myocardial Infraction (STEMI) patients, when percutaneous coronary intervention (PCI) cannot be performed. However, using clinical markers of reperfusion, thrombolysis is not always successful for all patients and immediate angiographicrescue PCI is indicated. Aim of the Work: Thegoal of this clinical study was to determinethe angiographic efficacy of thrombolysis in STEMI patients. Besides its correlation in successful or failed thrombolysis (FT) based on clinicalcriteria of reperfusion. Material/Methods: The study population included patients with acute STEMI within 12 hours of onset chest pain, who were admitted to The Cardiac Intensive Care Unit of cardiology department, atUniversityHospital Center Mohammed VI of Marrakech Morocco, receiving thrombolysis with Tenecteplase, during the period from January2021 to January2023. Repeated Electrocardiogram (EKG) at baseline, 90 minutes after Thrombolysis to define FT and PCIwereperformedfor all patients. Results:121 patients with a mean age of 56 years were recruited in the study. Successful thrombolysis was present in 60% of patients (n = 73) in Group I, while 40% of patients (n = 48) had FT in Group II. There was no significant difference between patients in both groups regarding gender, risk factors for coronary artery disease like dyslipidemia, diabetes mellitus, obesity, smoking, and myocardial infraction territory on the EKG. However, hypertension, delayed presentation after six hours of onset chest pain, and severe alteration of the systolic ejection fraction were mostly present in Group II. The TIMI III flow rates represent 76%(n = 93) of the patients in the study, with higher rates in both groups, at 80% versus 70% for groups I and II, respectively. Conclusion: The study confirmed that unsuccessful thrombolysisdoes not mean always-unsuccessful restoring of epicardial coronary flow.As a result, our current results clearly demonstrate the benefits of fibrinolysisfor STEMI patients when resources are limited for primary PCI. However, Additional clinical studies are also needed to investigate the recovery of microvascular and tissular perfusion to improve myocardial function and long-term clinical outcomes.

Molecular docking analysis of Ficus religiosa L. fruit extracts with HMG-COA reductase inhibitors, anti-hyperlipidemic effects of its in Albino wistar rats, triggered by Triton-X 100 and High fat diet

Hyperlipidemia is the major risk factor for coronary artery disease in various patients suffering with cardiovascular disorders. Literature claims that flavonoids and phenolic compounds are able to reduce hyperlipidemia. Aim of the present study is to establish antihyperlipidemic activity of Ficus religiosa L. fruits extract with molecular docking approach and perform in-vivo study.Extraction has performed by Soxhlet apparatus with methanol for 72 h. Further, the extract has subjected to phytochemical tests followed by GC-MS analysis. Molecular docking study has been conducted to screening the compounds in extract which have affinity to HMG-COA reductase (PDB ID: 1HWK) receptor with reference to Atorvastatin. Anti-hyperlipidemic activity of the extract has investigated by studying in vivo effects on Triton-X 100 and High fat diet induced animal model. The animals were divided in 5 groups of 6 each. The extract has administered at a dose of 1000 mg/kg (p.o) and 500 mg/kg (p.o) to both models. Atorvastatin was used as standard.The GC-MS result of Ficus religiosa L. fruits has demonstrated the presence of phenols, flavonoids. Molecular docking study has been performed to identify the anti-oxidant compounds in the extracts. The extract has shown a significant decrease in the levels of Body weight, serum cholesterol, glucose, triglyceride, LDL, VLDL and significant increase in the level of serum HDL. The result of the research has showed that Ficus religiosa L. fruits possess antihyperlipidemic activity in both groups; the results were statistically significant compared to Atorvastatin.

Subacute behavior of glucose and blood pressure of type 1 diabetic people after strength exercise session: Study protocol

Background: Type 1 Diabetes Mellitus (DM1) is characterized as a severe insulin deficiency resulting from the destruction of beta cells in the pancreas, associated with autoimmunity. The clinical picture of a patient with DM1 includes symptoms such as abnormal thirst, dry mouth, sudden weight loss, frequent urination, lack of energy, tiredness, constant hunger and blurred vision. Systemic arterial hypertension (SAH) is characterized by high levels of pressure in the arteries, being associated with risk factors for coronary artery disease; cerebrovascular accident (CVA); myocardial infarction; heart failure and kidney failure. Regular physical activity in these patients is associated with a reduced risk of future cardiovascular disease, better long-term glycemic control, better cardiovascular fitness, better quality of life, reduced daily insulin requirements and better weight control. Furthermore, it plays an important role in the primary and secondary prevention of diabetes cardiovascular disease, improving general health and well-being. Objective: The present study aims to evaluate the effects of strength training on glycemic parameters after an exercise session, in adult type 1 diabetic individuals, through a randomized controlled clinical trial. Methodology: The sample will be made up of 30 participants with DM1, made up of men and women based on the inclusion/exclusion criteria. Discussion: Practicing physical activity reduces the need for hypoglycemic drugs, also improves metabolic control and helps obese patients lose weight, reducing the risk of cardiovascular diseases and improving the quality of life of these patients. The practice of strength and aerobic training as a non-drug treatment is systematically found in the literature as a fundamental strategy for reducing systemic arterial hypertension and maintaining the cardiovascular system. Both resistance exercise and Pilates are effective for individuals with type 1 diabetes, improving metabolic and clinical control, especially when combined with adequate nutrition and amino acid supplementation. Physical activities reduce the need for hypoglycemic medications, help with weight loss and reduce the risk of cardiovascular diseases. Regular exercise, especially intermittent, significantly reduces the risk of acute hypoglycemia. Furthermore, it improves HDL and LDL levels, essential for reducing cardiovascular risks. Strength and aerobic training are essential for controlling high blood pressure and improving quality of life, with three weekly sessions being recommended for satisfactory results.

Association between Estimated Small Dense Low-Density Lipoprotein Cholesterol and Occurrence of New Lesions after Percutaneous Coronary Intervention in Japanese Patients with Stable Angina and Receiving Statin Therapy.

Low-density lipoprotein cholesterol (LDL-C) is considered the most important risk factor for coronary artery disease (CAD). Although lipid-lowering therapy using high-intensity statins for patients with stable CAD is one of the cornerstones of medication therapy, there is still a risk of residual cardiovascular events, even after controlling for LDL-C. Recently, attention has focused on the association between small dense LDL-C as a residual risk factor for CAD, and it has been reported that a formula can be used to calculate the small LDL-C. We investigated the association between estimated small dense LDL-C (Esd LDL-C) and the occurrence of new lesions with myocardial ischemia 2 years after percutaneous coronary intervention (PCI) in 537 patients with stable angina who underwent PCI. In this study, all patients had been prescribed statins. This study was based on previously reported data regarding the relationship between non-high-density lipoprotein cholesterol levels and stable angina pectoris after PCI. Revascularization, including new lesions and in-stent restenosis, and new lesions appeared in 130 and 90 patients, respectively, 2 years after PCI. Age, diabetes mellitus (DM), LDL-C, and Esd LDL-C were associated with the occurrence of revascularization and new lesions 2 years after PCI. Multivariate logistic regression analysis models revealed that Esd LDL-C [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.004-1.048, p = 0.020; and OR 1.03, 95% CI 1.009-1.057, p = 0.007, respectively] were associated with the revascularization and occurrence of new lesions 2 years after PCI. As well as total cholesterol and LDL-C, Esd LDL-C was an independent risk factor for the revascularization and occurrence of new lesions 2 years after PCI for stable angina in Japanese patients receiving statin therapy. In patients with stable angina who are on lipid-lowering therapy with statins, calculating the Esd LDL-C may provide useful information for predicting revascularization and the occurrence of new lesions.

Anxiety, a significant risk factor for coronary artery disease: what is the best index

BackgroundCoronary artery disease (CAD) is known as the leading cause of disability and death globally. Anxiety disorders are also recognized as common types of mental disorders that substantially impact global health. Iran ranks among the countries with a high incidence of CAD and anxiety disorders. Therefore, the present study aims to determine the potential association and epidemiological aspects of anxiety and CAD within the population of Mashhad, the second most popoulos city in Iran.MethodsThe present study is based on extracted data from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study which is a 10-year prospective cohort study intended to assess the effects of various CAD risk factors among Mashhad city residents. Anxiety scores were assessed at the baseline using Beck Anxiety Inventory and individuals were classified based on the BAI 4-factor structure model which included autonomic, cognitive, panic, and neuromotor components. Accordingly, the association between baseline anxiety scores and the BAI four-factor model with the risk of CAD events was analyzed using SPSS software version 21.ResultsBased on the results, 60.4% of the sample were female, and 5.6% were classified as having severe forms of anxiety. Moreover, severe anxiety was more prevalent in females. Results showed a 1.7% risk of CAD (p-value < 0.001) over 10 years with one unit increase in anxiety score. Based on the 4-factor model structure, we found that only panic disorder could significantly increase the risk of CAD by 1.1% over the 10-year follow-up (p-value < 0.001).ConclusionAnxiety symptoms, particularly panic disorder, are independently and significantly associated with an increased overall risk of developing CAD over a 10-year period. Therefore, further studies are warranted to investigate the mechanisms through which anxiety may cause CAD, as well as possible interventions to mitigate these processes.

Repair of a right coronary artery rupture with perforated right ventricle following spontaneous pseudoaneurysm: a case report

BackgroundFollowing the rupture of a coronary artery, a patient’s condition usually deteriorates rapidly due to cardiac tamponade. A pseudoaneurysm due to a coronary artery rupture is rare; however, when a spontaneous coronary artery pseudoaneurysm occurs without tamponade, it creates a fistula in the right ventricle, often requiring surgical repair.Case presentationThis report describes the case of a 68-year-old man who presented with chest discomfort after a 12-day course of antibiotic treatment for bacteremia. Following coronary angiography, echocardiography, and enhanced computed tomography, he was diagnosed with a right coronary artery pseudoaneurysm accompanied with perforation of the right ventricle. Severe adhesions were observed during emergency surgery surrounding the entire heart. The patient presented with risk factors for coronary artery disease, including hypertension and smoking history. His coronary artery was severely calcified due to end-stage renal failure requiring dialysis; thus, a covered stent could not fit inside the arterial lumen. Consequently, coronary artery bypass grafting to the right coronary artery and right ventricle repair were performed. Unfortunately, the patient died postoperatively due to sepsis from intestinal translocation. This rare development was hypothesized to be an incidental result of the combination of severe post-inflammatory adhesions, extensive coronary artery calcification, and rupture of the calcification crevices.ConclusionsIn the case of a severe post-inflammatory response, shock without cardiac tamponade may require further scrutiny by assuming the possibility of inward rupture. For patients in poor condition, two-stage surgical treatment might be considered after stabilization with a covered stent.